Clinical Practice Guideline
Group B Strep
Prevention of Perinatal Group B Streptococcal Disease
(Endorsed with Qualifications, April 2010) (Affirmation of Value, May 2015)
The guideline, Prevention of Perinatal Group B Streptococcal Disease, was developed by the Centers for Disease Control and Prevention and was endorsed with qualifications by the American Academy of Family Physicians in 2010. The endorsement process has since been modified and the guideline was re-reviewed and categorized as Affirmation of Value.
- All pregnant women should be screened at 35-37 weeks gestation for vaginal and rectal Group B Streptococcus (GBS) colonization, unless GBS was isolated from their urine at any time during the current pregnancy or they had a previous infant with invasive GBS disease. Women who have had GBS isolated from their urine or who have had a previously infected infant do not need to be screened and should be treated as if they had a positive test for GBS colonization.
- At the time of labor or rupture of amniotic membranes, intrapartum antibiotic prophylaxis should be given to all women who tested positive for GBS colonization.
- When screening results are not available, intrapartum antibiotic prophylaxis should be given based on risk factors: less than 37 weeks and 0 days gestation, rupture of membranes ≥ 18 hours, or temperature ≥ 100.4°F (38.0°C).
- Penicillin is the agent of choice for intrapartum antibiotic prophylaxis, with ampicillin as an acceptable alternative.
- Penicillin-allergic women who are not at high risk for anaphylaxis (no history of anaphylaxis, angioedema, respiratory distress or urticaria following administration of a penicillin or cephalosporin) should receive cefazolin.
- Penicillin-allergic women at high risk for anaphylaxis should have susceptibility testing ordered for their GBS cultures. They should receive clindamycin only if their GBS isolate is sensitive to clindamycin and erythromycin, or is sensitive to clindamycin with a negative test for inducible resistance.
- Penicillin-allergic women at high risk for anaphylaxis should receive vancomycin if their GBS isolate is not sensitive to clindamycin or susceptibility is unknown.
- Any newborn with signs of sepsis should receive a full diagnostic evaluation (blood culture, CBC with differential and platelet count, chest x-ray if abnormal respiratory signs, and a lumbar puncture) and receive antibiotic therapy pending culture results.
- Well-appearing newborns whose mothers had suspected chorioamnionitis should undergo a limited evaluation (blood culture, CBC with differential and platelet count) and receive antibiotic therapy pending culture results.
- Well-appearing infants whose mothers received adequate intrapartum antibiotic prophylaxis (penicillin, ampicillin, or cefazolin ≥ 4 hours prior to delivery) or whose mothers received no or inadequate prophylaxis without other risk factors, should be observed for ≥ 48 hours. No routine testing is recommended.
- Well-appearing infants whose mothers received no or inadequate intrapartum antibiotic prophylaxis and are < 37 weeks gestational age or membranes were ruptured ≥ 18 hours before delivery should be observed for ≥ 48 hours and should undergo a limited evaluation.
Access article with full recommendations for more information on prevention of perinatal Group B streptococcal disease, including recommendations for women undergoing cesarean delivery, NAAT site-of-care testing, algorithm for threatened preterm delivery, and algorithm for newborn management.
These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.